Ventricular Fibrillation Cardiac Arrest in African American Male with Apical Hypertrophic Cardiomyopathy

Abstract

Apical hypertrophic cardiomyopathy (AHCM) is a rare form of non-obstructive hypertrophic cardiomyopathy. It is rarely reported in African American patients, and more commonly reported in Japanese patients. AHCM involves hypertrophy of the apex of the left ventricle. It is considered to have a benign prognosis in terms of cardiovascular mortality, however arrhythmias and sudden cardiac death have been reported. We report a case of a 49-year-old African American male with a history of hypertension, who presented to the emergency department after in field defibrillation for ventricular fibrillation cardiac arrest with return of spontaneous circulation after 10 minutes of cardiopulmonary resuscitation. Features of left ventricular hypertrophy and deep T-wave inversions in V3-V6 were noted on a 12-lead electrocardiogram which were suggestive of AHCM. Left heart catheterization with left ventriculography and coronary angiography confirmed the diagnosis of AHCM with the classic “ace of spades” sign. This case highlights the rare occurrence of AHCM with ventricular fibrillation cardiac arrest in an African American male, treated with hypertension management, aspirin, atorvastatin and automated implantable cardioverter-defibrillator placement.

High-Risk Apical Hypertrophic Cardiomyopathy Requiring an Implantable Cardioverter-Defibrillator: A Case Report of an Overlooked Etiology

“…As for our patient, we believed the presence of LGE >15% of total LV mass raised the risk for arrhythmogenic SCD and thus performed ICD placement. Indeed, as suggested by both cohort studies and case report literature, the risk of SCD in apical HCM is not negligible [12][13][14][15]. A recent retrospective study found that patients with apical HCM had an estimated SCD rate of 2.7% per year in their sample population, of which a personal history of unexplained syncope, non-sustained ventricular tachycardia (VT), and LGE by CMR were common risk factors noted [12].…”

“…The risk of not pursuing device therapy in apical HCM has been highlighted in case report literature. In one case, a patient experienced ventricular fibrillation (VF) cardiac arrest and subsequently received an ICD for secondary prevention [ 14 ]. In that case, the patient denied a family history of recurrent syncope or unexplained cardiac death but reported unspecified cardiac hypertrophy, arrhythmia in one brother, and coronary artery disease in their mother.…”